<div class="qualifiedBox">
    <div class="header">
        <div class="headerLeft">
            <p>深圳中检联</p>
            <p>第三方监管有限公司</p>
        </div>
    </div>
    <div class="mainBox">
        <div class="mainRow">
            <div class="mainLeft">样品编号：</div>
            <div class="mainRight mainRightWrite"></div>
        </div>
        <div class="mainRow">
            <div class="mainLeft">样品名称：</div>
            <div class="mainRight mainRightWrite"></div>
        </div>
        <div class="mainRow">
            <div class="mainLeft">测试项目：</div>
            <div class="mainRight mainRightWrite"></div>
        </div>
        <div class="mainRow">
            <div class="mainLeft">样品状态：</div>
            <div class="mainRight mainRightCheckbox">
                <div class="sampleBox">
                    <input type="checkbox" name="sampleStatus" id="reservedSample">
                    <label for="reservedSample">留样</label>
                </div>
                <div class="sampleBox">
                    <input type="checkbox" name="sampleStatus" id="reservedRetest">
                    <label for="reservedRetest">复测</label>
                </div>
                <div class="sampleBox">
                    <input type="checkbox" name="sampleStatus" id="reservedWaitetest">
                    <label for="reservedWaitetest">待测</label>
                </div>
                <div class="sampleBox">
                    <input type="checkbox" name="sampleStatus" id="reservedtested">
                    <label for="reservedtested">已测</label>
                </div>
            </div>
        </div>
        <div class="mainRow">
            <div class="mainLeft">储存条件：</div>
            <div class="mainRight mainRightCheckbox">
                <div class="sampleBox">
                    <input type="checkbox" name="samplecondition" id="reservedCold">
                    <label for="reservedCold">冷藏</label>
                </div>
                <div class="sampleBox">
                    <input type="checkbox" name="samplecondition" id="reservedFrozen">
                    <label for="reservedFrozen">冷冻</label>
                </div>
                <div class="sampleBox">
                    <input type="checkbox" name="samplecondition" id="reservedNormaltemp">
                    <label for="reservedNormaltemp">常温</label>
                </div>
            </div>
        </div>
    </div>
</div>

<style>
    .qualifiedBox {
        width: 300px;
        padding: 10px 10px;
        float: left;
    }
    .headerLeft {
        font-size: 10px;
        text-align: right;
    }
    .headerLeft p {
        margin: 0px;
        padding: 0px;
    }
    .mainLeft {
        font-size: 16px;
    }
    .mainRow {
        display: flex;
        height: 24px;
        line-height: 24px;
    }
    .mainRightWrite {
        border-bottom: 1px solid #000;
        flex: 1;
    }
    .mainRightCheckbox {
        display: flex;
        font-size: 10px;
        align-items: center;
        flex: 1;
        justify-content: space-between;
    }
    .sampleBox {
        display: flex;
        align-items: center;
        justify-content: center;
    }
</style>